Thomas Rathwell

Running to stand still: change and management in Canadian healthcare.

There is a pervasive belief among health system reformers that new public management techniques such as decentralization and market-based approaches will provide the answers to what ails healthcare systems. In this first installment of a two-part discussion, the assumptions and empirical evidence underpinning these techniques are scrutinized, and the effect of their implementation on those who manage the healthcare system is assessed. Other paradigms for delivering healthcare will be considered and described in the second article of this series. Healthcare systems around the world have been buffeted by rising costs, perceived inefficient use of resources, and consumer and provider dissatisfaction with the delivery and outcomes of care.

A framework for involving the public in health care coverage and resource allocation decisions

Coverage and resource allocation decisions are a very important area for public engagement because of their direct impact on the publics access to care and because the affected services are publicly funded. We present a framework that guides decision-makers through key questions they must address when deciding on, structuring, evaluating and disseminating the results of public engagement exercises, particularly as they relate to coverage and resource allocation decisions. The framework will enable decision-makers to better conduct viable and meaningful citizen engagement around these issues.

Restructuring the Healthcare Management Paradigm: Toward Organic Management:

In the first part of this two part series, we demonstrated that the adoption of production engineering techniques and market-based approaches to the delivery of healthcare have not fulfilled their initial promise. Furthermore, this has placed managers under duress, because they are charged with implementing these mechanisms. In this second article, we propose a new philosophy for managing healthcare organizations that is closer to the roots of healthcare delivery in Canada.

Deciding whether to engage the public on health care issues.

Health care decision-makers often face calls for greater public participation or see increasing public engagement as part of their organizational mandate. This article identifies six questions decision-makers must consider when deciding whether to formally engage the public or other stakeholders around a particular health care issue. These questions focus on (1) the clarity of the issue for public engagement, (2) the appropriateness of the issue for public engagement, (3) the extent to which there are viable options, (4) the role for the public, (5) whether the public likely want to be involved and (6) consideration of the expected advantages and disadvantages of public engagement.